Lessons Learned

As we approach the end of the year, it is a wonderful time to reflect and take stock on what we’ve learned. Some learnings are easy, many come through unexpected challenges.  We’ve asked our consultant team to share some of the lessons that have emerged for them this year, and hope they provide you with insights that you will find helpful.
Experience Fun!
What I’ve settled on is as much something I aspire to, as something I’ve learned. Here it is. Life may turn out to be shorter than we had imagined, but one thing is for sure – Life is definitely better than we could have ever imagined. We have all been richly blessed. There’s so much joy and beauty available to us every day, and so much fun to be had in almost every moment. I’ve learned that I want to be more lighthearted and playful, and really experience all the fun that’s available to us. This is a bit of a reach for a serious, hard-working German girl like me, so if you see me off track, please remind me to lighten up.
Clean House
One of my lessons focuses on my 2017 year of “cleaning house” – both literally and figuratively.  Sold my condo, said goodbye to being Condo Board president for 15 plus years, now sharing a tiny little house with my sweetie, gave away more than half of my furniture…. and simplified.  The smallness is comforting, the shedding of “stuff” allowing me to breathe more freely.  Marie Kondo’s book, “The life-changing magic of tidying up” was inspiring.   Admittedly, progress on eliminating “keepsakes” and books/documents (some of which are still sitting in the basement…old family photographs (half of the faces not identifiable!), the syllabus for a class I “might” teach, past work creations) are slower-going, as Kondo suggests they can be – but my progress is real, shedding a light on how “tidying up” has freed (and continues to free) my mind and my soul.
Be Present!
I have come to carry 3 words with me this year that have meant A LOT! Be. Here. Now. They point me to the understanding that the present is all I have, and I dare not waste this precious resource by micro-planning every little step of an anticipated experience, nor replaying (and often affirming my own righteousness in) an unpleasant past experience. “Be here now”, has helped me stop to breathe, to stop the flow of words in my head, and to listen to the sound of my heart, my breath, or the silence inside me. Quieting my mind has become a practice I look forward to every morning. . . I am an early riser and I love to watch dawn color the sky. Being here now, in the present, is also directly linked to presence, which is the very best part of myself that I can give to another. Or to the sunrise.
Manage Anger and Frustration
I have been working hard to control my anger and frustration when situations arise. Since I am the only person that knows when anger is building, I have learned to recognize the danger signs when they begin. I can choose how to react in a situation and just because my first instinct is to become angry doesn’t mean it is the correct response.  I realize that when I start to get angry I need to stop what I am doing and breathe deeply. This interrupts my angry thoughts and helps put me back on a more positive path. Also, if I imagine how I look and behave when I am angry I probably would not want to be around someone like that.  A great person once shared that if I “Pause, find Peace and Pray, I can’t but help create an Attitude of Gratitude.”
Redefine Time  – this came up twice! As consultants, we are not bound by the typical 9 – 5 clock of an employee. Does this impact how we see time?
I have been challenging my misconception about time. . . the clock is useful for some things, but not as a way to experience and evaluate my life. Have I done everything I wanted to do before I turned a certain age? Did I get everything finished that I wanted to do on Friday? What crazy pressures! Because my life is no longer constrained by the clock, I am experimenting with the natural rhythms and ebb and flow of things . . .like my energy, the need to balance work, play and rest, the times for eating.
One lesson for me this year is to be mindful of how I spend my time. I am aware that time is a finite commodity. Am I doing what I want to be doing? What I need to be doing? Or am I just doing?  I am working at being more aware of the choices I make in how I spend my time both at work, in volunteer capacities and at leisure. Even when all I am doing is playing spider solitaire on my cell phone, I can give myself permission to be in a restful state — almost meditative — accepting that down time is a reasonable choice sometimes rather than berating myself about “wasting time.”  And I can make intentional decisions about the work I choose to do — having fun, finding meaning and earning money!  Rather than feeling obligated or compelled to work at things that are stressful and demotivating.  (Yes, I am fortunate to be able to choose this.) And I am finding that being is a valuable way to spend my time — being with family and friends, being outdoors, and being with my colleagues – with you all … who provide me with energy, perspective and support.
See Beyond our Thoughts
I’d say the most important lesson I’ve learned this year is to realize that I don’t need to believe everything I think or anything that anyone else thinks. I grew up in a household that was incredibly loving, full of extended family members who created a safe space for me and my cousins to play and laugh. It was also a household where “father knows Best” and everyone else’s thoughts came in second or third or nowhere at all.
So, in college, I was suddenly in a place where everyone wanted to know what I thought. Thinking was encouraged. And I got to voraciously read and discover other thinkers thorough-out history. I got to organize my thoughts around theories that inspired me and writers who were so articulate in discussing and defending their thoughts. I had many many journals which I used to express my thoughts about everything. You could say I became enamored by my own thoughts. And eventually gained expertise in helping myself and others explore their thought patterns, understand their origins, determine whether they were limiting beliefs and learn to shift or change them to create better results.
So, you can imagine my surprise, during my final year of my doctoral program, as I’m finishing up a 400+ page dissertation, to realize that I don’t need to believe what I think and that I don’t need to even heal my thoughts or shift my thoughts or have anything to do with my thoughts.  And that there’s a space beyond thought, a place of Presence and stillness and nothingness that holds more beauty, more potential, more joy than any of my thoughts or other people’s thoughts could ever imagine or express.
This experience is allowing me to relax into being “ordinary” and free to be with other people’s thoughts without the need to be on the defense or offense of anything. It’s bringing into my life a sense of groundedness and compassion and curiosity and insights the likes of which I have never experienced before.
Accept Ourselves as We Are
This year has been a year of unfolding awareness around the passage of time – of shifts in the way I hold myself in relationship to the world, an enlarging awareness that my presence – our presence – on the earth is but temporary, and the startling reality that things I never expected have planted themselves firmly in the landscape of my life.
I have been toying with existential questions – why are we here, what purpose does any one individual have, what is the meaning of this thing we call life?  I invited myself to lift and lift and lift above the details of the daily human experience and really try to SEE what made sense about life and living.  What a surprise when I realized that my presence on this earth – from a larger perspective – is absolutely and utterly insignificant!  Creation will not care if I eat kale or write bad music or am good at cleaning the kitchen.  I will not invent the light bulb or paint the Sistine Chapel or have my name attached to some doctrine.  The details of my daily life are inconsequential, and I am not required to place any kind of signature whatsoever on human history.
Paradoxically, the moment I had that realization was the same moment in which I understood fully that it is my own unique way of being, instead of my way of doing, that contributes to all of creation in a way that is meaningful and sustains the goodness that surrounds us always, whether we know it or not.  It was the moment in which I knew, without doubt, that expanding in love and kindness, compassion and generosity, caring and integrity, honesty and grace and offering THAT to the world (and to myself) is truly the only job I have as a human being.  Less doing, more Being!
So, let time fly or drag or whatever it does today or tomorrow.  My intention is to love every moment of this glorious, mysterious, messy, confusing gift called life – and to graciously forgive myself if I slip now and then!  To paraphrase one of my favorite sayings – when the tide rises ALL boats rise!!
And we invite you to share your lessons learned or your aspirations for next year with us as well in the spirit of giving that frames this time of year. Here’s a start on 2018. . . 
Study Sound
Next year I want to study sound, and the effect it has on our lives. . . the good, the bad, and the ugly. When friends from a big city come to visit me in rural Arizona, they consistently say, in a reverent way, “It is so quiet here!” The effect of abusive noise, including those noises in our heads, and the benefit of beautiful sounds (like Joyce’s harp at the Summit) are topics I want to explore.
Thank you to all our contributors: Julie Wechsler, Jill Bachman, Michael Cavanaugh, Mary Lockhart, Rory Gilbert, Noushin Bayat, Carla Rotering

Reflections on Being of Service: Leadership Summit 2017

Thunderbird Leadership held its 11th Leadership Summit on Friday, November 10th. When the planning team convened, they discussed its proximity to Veterans Day and we were all taken by the notion of service. What does service mean? How do we serve? Who benefits? The day evolved into exploring notions of service, mercy and compassion…recognizing potential avenues to impact others as well as the need to care for ourselves so we have the genuine capacity to serve.

Dr. Gladys McGarey was the keynote speaker. She will be celebrating her 97th birthday this month and shared the story of her life in decades starting with her early childhood in northern India where her parents were medical missionaries. Clearly, she was born to service. Her story depicted a life of courage, seeking truth, and finding ways to bring healthful living to people throughout the world. We were struck by her challenge to change the medical model from “a war against disease,” to one that seeks life and balance – moving from fear to love. Her story was spellbinding and the consensus was that we could have listened to her all day!

How often do we take time to truly listen to others’ stories? Each of us has a tale to tell of how we arrived at this moment in time.

Our next speakers were Dr. Gladys’ extended family – who spoke about well-being. Julie Wechsler, a certified executive and well-being coach, shared factors that matter for overall well-being in our lives and differentiated surviving and thriving. She integrated how service was a critical part of thriving and introduced her daughter-in-law, Ashley, to share what service has meant to her. Ashley told her heartfelt story of being a “Big” for Big Brothers, Big Sisters and how it has profoundly changed her life. Ashley has been a Big Sister to the same girl for seven years…their families now entwine even more with connections, love and honor with Ashley’s Little Sister’s brother and sister.

The message was loud and clear – when we give, we receive.

Dr. Carla Rotering talked about mercy and forgiveness. Her gentle, thoughtful and deep remarks challenged us to “radical mercy,” to have compassion for ourselves and others without evaluating who “deserves” it. How do we navigate the world if we believe people are doing the best that they can? How do we treat ourselves if we believe that about ourselves? What is the impact on the world? Dr. Rotering completed her presentation with a poem she wrote, “The Reckoning,” that left us speechless – a journey from doubt and pain, to compassion and self-acceptance.

And the tenderness of your true heart rises up to meet you
At the higher place to which you have come
And the shroud that has bound the secrets to your spirit for so long
Simply falls away.”
Carla Rotering, 2002

So, here we are at a Leadership Summit about service and we are being asked to take care of ourselves – recognizing that we cannot genuinely serve others if our own self is untended, uncared for. I am reminded of a concept from Dr. Brene Brown who stated that the people who are the most compassionate have the best boundaries. They know themselves, care for themselves and act from the heart, from love and “radical mercy,” not from obligation.

And the truth is, we can all feel that difference, can’t we?

In the afternoon, we heard from Katie Owens and her story of resilience, depicting how we can move from disappointment and rejection to new opportunities and possibilities. Once again, the message is about inner strength making space for genuine service.

Out beyond stories of right-doing and wrong-doing, there is a field, I’ll meet you there…”  Rumi

And finally, Mary Lockhart, Noushin Bayat and I finished the day looking at how the messages we tell ourselves impact our ability to act, to serve. Back to stories once again! We challenged ourselves and our participants to differentiate fact from fiction, observation from interpretation. We asked participants to “turn to wonder” when things get difficult, turning away from, “I don’t,” “I can’t,” “I never,” and opening possibilities for new stories and new perspectives, concluding with a quote from Viktor Frankl,

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

And then, the day was over. Our heads were filled with messages of care, compassion and passion for ourselves and for others…to see the world in a new way and to find our place of impact, not to wait for the right time, but to make today the right time.

P.S. – There were so many fabulous contributors to the day that enhanced the experience of the Summit for everyone. Check our photo gallery to see the support of our sponsors, imagine the day graced by harpist Joyce Beukers, massage therapist Heather Paslay and graphic documentarian Stephanie Levine. A Silent Auction inspired generous giving which netted well over $2000. Every participant had a chance to submit “their” charity of choice for the Silent Auction proceeds, and this year, the Humane Society was the lucky recipient. We hope you will be able to join us next year!

Warriors for the Human Spirit

I had the pleasure of participating in the planning and presentation of a Leadership Intensive for Nurse Leaders October 19-21. The attendees arrived on a Thursday evening, weary from their work week and a bit uncomfortable in a new environment with strangers. We did our best to help them feel comfortable and pampered in a beautiful, fall-desert setting with beautiful gardens and accommodations.

This was a first-class offering with expert speakers from around the country; each integrating their expertise, insight and wisdom into their presentations and case studies. I realized as I listened that each of the speakers was also a warrior for the human spirit, approaching their work with gentleness, decency and bravery. They shared stories of creating strategies that would move their area of influence forward over the long haul. They focused their passion and energy on what was possible, albeit often difficult and/or unpopular but needed, to accomplish the vision and create healthier environments.

I watched the weary-leader participants perk up, sit up, get engaged in the discussions. We provided them with new tools that would help them see and shape their organizations in new ways. We also shared our view of the needed leadership attributes for today’s world of disruption and chaos, in order to influence more effectively, achieve personal success, healthier environments and sustainable results. Each attendee walked away with the beginnings of a plan to address a difficult problem they were dealing with. And they left with a network of new colleagues and friends with whom they will connect over the months to come.

I too left energized, knowing deep inside that we are preparing the next generation of leaders to lead from a new place. This place acknowledges the importance of nurturing the human spirit while leading with competence in today’s dynamic and complex systems.

Kathy Scott, RN, PhD, FACHE

The Heart of a Good Story: from Information to Meaning

When you reach for the newspaper or your favorite newsfeed, do you feel overwhelmed with data, facts and figures, and have trouble making sense of the information out there? I do. For me it’s like swimming in lukewarm chicken soup hoping for a noodle of something to hang onto to tell me where I am. In our modern minute-by-minute explosion of facts, how do we get from information to meaning?

Good story telling has its place not only at parties with friends, it is a tremendously useful skill for leaders. Sharing a story- one that resonates with others and makes them wonder who they are going to tell it to next- is a compelling way to connect with people. And as Jim Kouzes reflects * “Stories are a powerful tool for teaching people about what’s important and what’s not, what works and what doesn’t, what is and what could be. Through stories, leaders pass on lessons about shared values and get others to work together.” In a nutshell, stories accomplish what charts, graphs and reports cannot.

Like many others I know, I wish I were better at story telling. My endings always seem kinda weak, I’m not sure where I’m going, and I rarely get the response from others that I’d like. Do I meander, do I have a point, is my point even important? How, I wonder, can I improve my storytelling?

Here are some ideas I have come across in my quest to better persuade and inspire others with what I have to say.

1. Begin the process by thinking about the message (should be brief) that you want people to connect with. Once you have the message clear and simple, then work on how to illustrate it.

2. Use your own experience. The best stories reveal vulnerabilities that show the story teller as human, authentic and accessible. This helps to create the very important personal connection.

3. Start keeping a log or journal of important points and messages you want to deliver to your team. And jot down stories from your past, especially those gripping ones about hardship, conflict, loss, overcoming barriers, that could be used to make your message come to life.

4. Make sure your audience understands the context for your story. If you’re not sure who will be the audience, look for the common denominator level in your story that most people can relate to. Does it make sense for a high school senior at her first job as well as a corporate CEO?

5. Don’t be the hero in your story . . . be in it, but make sure it’s not ABOUT you.

6. Keep the story simple with the idea that less is more. Provide just enough detail to enhance important parts, especially to help listeners connect with the emotion and the imagery, to feel like they are right there with you. If it doesn’t move the story along, get rid of it.

7. Once the story is created, practice telling it, especially the beginning and the ending. Where will your brief message come in? Is it stated or not? Is it important at the beginning AND the end? Write it down.

Stu was a quiet man who spoke when he needed to, but just like EF Hutton, when he spoke, everybody listened. In his presence you had the feeling that he was always thinking, always “on”, and aware of his impact on others.

Our nonprofit organization faced a financial crisis, one that was totally unexpected, and HUGE. In just 24 hours we were shocked to discover that we needed twice as much money as we had laboriously raised to get us through the next fiscal year. We were so tired of the stress of wondering if we would make it. To learn that we were NOT done really took the wind out of our sails. We sat there stunned. I was one of 8 members of the Finance Committee, and we didn’t have a contingency plan. Stu was the Chairperson.

Stu had called this special meeting. He refrained from calling it an emergency. And in that meeting he laid out his ideas, looking for our feedback and commitment. In addition to more typical actions, he wanted us to team up, then visit the “big givers” personally, and ask them for money. . . a specific amount to be exact. Whoa, I said to myself, you want me to do what? Those dollar amounts are really big!

We reviewed the list of people to target, identified what they had already given, then made an educated guess about what we could ask for without being laughed out of their homes. I was still feeling quite sweaty-palmed about this until Stu said, “Here are some rough talking points, I know they can be improved. But to help everyone feel more comfortable with this critically important role, why don’t we take 15 minutes to practice. Let me show you what I’m thinking.” And then he proceeded to role play the ‘ask’ with a member of the committee. He stumbled a little, others tried out their ideas. But he was out in front, the first.

I learned several things about leadership that day, but for me the biggest was that a good leader does everything he can to help his people succeed. My teammate and I were able to make the case for our appeal, and to do it authentically. And the Finance Committee met its goal. I will always remember that meeting, and Stu’s fine example.

What’s YOUR story?


* Duncan, RD. (1/23/2013) “Jim Kouzes: Why You Should Hone Your Storytelling Sills.” Interview. Blogpost of Duncan Worldwide. Duncanworldwide.com. Accessed 10/15/17.

Being of Service – the Stories That Inspire

On the Friday of Veteran’s Day Weekend, Thunderbird Leadership will be hosting its 11th Annual Leadership Summit. The notion of service logically emerged as the theme.
When we see folks in the military, we thank them for their service…they relinquish the many privileges that most of us take for granted to serve a greater good.
And the importance of service cannot be overlooked. There is a strong conviction in numerous belief systems to contribute to making the world a better place.
Each of us know stories of heroism, courage, purpose and forgiveness that inspire us and call us toward something better, something larger, toward the best version of ourselves.  Those who have embraced service as the central value of their lives loom in our mind’s eye as extraordinary, perhaps even as chosen in some inexplicable fashion.  We consider them with awe, wondering what it might be like to be an icon of such devotion, such commitment, such dimension, such altruism.1
But what of us? How do we see ourselves in the role of service?
Sometimes, acts of courage unfold in quieter and less spectacular ways.  Woven within our personal biographies are our own moments of courage, sharp purpose, of kindness and tender mercies – spectacular stories, ordinary stories and sometimes forgotten stories.  Captured in the details of our very own lives is the evidence that we each know the ways in which we, too, serve those around us and serve the greater good – and we know the deep fulfillment and connection that emerges when we consciously center our lives in service.
We have an illusion that our past is static, fixed in history…and yet, memory is really fluid. What we recall, the stories we tell ourselves, impacts what we think we are capable of. I am fascinated by the notion of how our memory serves us and am not sure what changes first, our thoughts and beliefs or the memories that inspire them.
At the Summit, we will have a chance to hear from Dr. Gladys McGarey, a pioneer in integrated medicine. She has had an amazing 97 years on this planet from her early years in pre-partition India with her medical missionary parents to her pioneering practice in the Phoenix area. When we talked about what she will present, she noted that the direction of her remarks will be influenced by her audience…what memories will we invoke? How will she inspire us?
We will all have an opportunity to share, to listen, to explore our own stories … to understand with new perspectives who we are, what we have accomplished and what we are capable of going forward.
We will also have a chance to challenge our stories. Are some of them outdated? Ones we need to rewrite? In graduate school many years ago, a professor asked me to lead a group on a project. I told him, “Oh no, I am not a leader, I am a good follower.” He looked at me with a puzzled expression on his face and said, “That may have been true in the past, but not anymore.”
And of course, I remember that story and use it in my own coaching practice.
So what do you tell yourself? What stories are generating energy and momentum in your life? What stories are dragging you down?
Join us for a day of stories, reflections, and delightful experiences as we honor those who serve, explore our own stories of everyday courage and embracing living and working from the heart of service.
For more information go to:

1 Content in italics from the invitation to Being of Service: Discovering Meaning, Courage and Mercy Through Personal Odyssey magnificently crafted by Dr. Carla Rotering for Thunderbird Leadership’s 11th Annual Summit

The High Wire Act in Healthcare

In last month’s blog post, and from a consumer’s point of view, I explored concerns with disparities in healthcare based on our social identities. I am a layperson whose work and life brushes up to the healthcare industry. More and more of my work seems to be in these borderlands – exploring effectiveness, connections and relationships, systems and organizations. And I read the papers and realize that the healthcare industry is in a high wire act of its own . . . not knowing how funding, finances, mandates and requirements will play out.
So, I encounter professionals every day who are trying to do their best for patients, employees, their organizations and their communities. How do executives maintain a stable course in the midst of so much turbulence?
I have had the opportunity to be a fly on the wall for the planning of a Leadership Intensive for Executive Nurses. I listen to three exceptional professionals as they discuss the critical elements that drive success in this chaotic environment: complex systems theories, leadership competencies, driving principles and implementation strategies. They consider compelling trends in value-based care, big-data, population health, technology, communication and empowerment.
I have watched a powerful event evolve from vision to reality in a way that will enable nurses in leadership positions to steer a steady course. What excites me about this program is how personal it is. The conveners (Amy, Kathy and Colleen) have designed a curriculum that asks participants to bring their whole selves to the table – to bring questions that need to be answered and to share their own wisdom and experience with other participants as well as with amazing speakers.
The Intensive is intimate . . . limited to no more than 25 participants . . . so that everyone is personally enriched. They will explore case studies that challenge the best minds and help prepare participants for the greatest challenges. They will design personal action plans and receive input and feedback to ensure the best possible outcomes. It will be intense, rewarding and impactful.
As a consumer, I want the people in charge to be making decisions that are well-considered by strong, thoughtful and capable leaders. I see the Leadership Intensive as a vehicle to allow leaders to step back, reflect and strengthen their ability to meet the myriad of demands of today’s healthcare environment.
For more information about the Leadership Intensive, October 19-21, 2017, and to register online for the conference, visit our events page.

What Difference Does It Make?

On Christmas Day a few years ago, while juggling suitcases at the airport, I hooked one on a pole, tripped over the wheel, and went skidding across the floor in my best belly flop position. It was quite dramatic. In addition to the acute embarrassment, I had a fabulous rug burn on my hand and jammed my shoulder as I caught myself in the fall.

A few weeks later, my shoulder was still out of whack. My weight trainer and my chiropractor (both women) recommended physical therapy. I went to my PCP (a man) to get an order for physical therapy. He checked me out, deemed it a soft tissue injury and said physical therapy was unnecessary because it would heal on its own in 6 to 12 months. I accepted what he said and dealt with the discomfort while continuing my workout regimen and not sleeping on that side. However, I wondered if I had been a 40 year old man, would my doctor have been as quick to expect me to wait it out for a year?
Currently, the health care industry is focusing a great deal of energy on the patient experience with training, assessment and whole departments dedicated to the provider-patient relationship and communication. As a patient, I am on the outside looking in and wondering how much attention is given to implicit bias in these programs?

In 2003, the Institute of Medicine produced a critical publication about health care entitled “Unequal Treatment”. The report concluded that “unrecognized bias against members of a social group, such as racial or ethnic minorities, may affect communication or the care offered to those individuals.” (Blair et.al., p. 71) It stated that people experienced differences in the quality of their healthcare based on their social identities: race, ethnicity, age, gender, socio-economic status, insurance status, and sexual orientation. (Blair et.al., p. 71)

Further research indicates that differences in the quality of care are also associated with conditions such as mental health issues, obesity and drug use. (FitzGerald, p. 13)

Since 2003, some of healthcare’s most turbulent issues (revolutionary medical interventions, increases in pharmaceutical costs, the controversy over the Affordable Care Act) have influenced expectations and outcomes for the industry. Is healthcare a right or a privilege? Should health and longevity be based on one’s financial or social status? How should healthcare be allocated and compensated? These public policy issues continue to be debated and at this time, the outcomes are not known.

What has not changed fourteen years later is the fact that who we are impacts the care we receive. Numerous studies since then reaffirm that implicit or unconscious bias impacts our relationships with our caregivers, the quality of our communication, and the diagnoses and treatments we receive. (The Joint Commission, p. 1)

How does this play out? Examples from the research include impacts on three areas:

Communication and relationship:

  • People with more implicit ethnic/racial bias have poorer interpersonal interactions with minority individuals, often in very subtle ways. Such interactions may contribute to a lack of trust and commitment on the part of the patient, leading to poor adherence. (Blair et. al., p. 73)
  • Besides influencing judgments, implicit biases show up in our non-verbal behavior towards others, such as frequency of eye contact and physical proximity. Implicit biases explain a potential difference between what a person explicitly believes and wants to do (e.g. treat everyone equally) and the hidden influence of negative implicit associations on one’s thoughts and actions. (FitzGerald & Hurst)
  • Stereotype threat may impair patient-clinician communication, reduce self-efficacy, and increase mistrust. (Blair et.al., p. 75)

Diagnosis and treatment:

  • Non-white patients receive fewer cardiovascular interventions and fewer renal transplants.
  • Black women are more likely to die after being diagnosed with breast cancer.
  • Non-white patients are less likely to be prescribed pain medications.
  • Black men are less likely to receive chemotherapy and radiation therapy for prostate cancer and more likely to have testicle(s) removed.
  • Patients of color are more likely to be blamed for being too passive about their health care. (The Joint Commission, citing van Ryn)

Patient behavior:

A 2011 study conducted by van Ryn et al. concludes that racism can interact with cognitive biases to affect clinicians’ behavior and decisions and in turn, patient behavior and decisions, such as higher treatment dropout, lower participation in screening, avoidance of health care, delays in seeking help and filling prescriptions, and lower ratings of health care quality.

While there is evidence that conscious or explicit bias has declined significantly over the past 50 years, there is no evidence of change in unconscious or implicit bias. This is profoundly disturbing for people who express, believe and desire to treat all people equally. (Blair et. al.)

Call to Action

We know that most health care providers truly want the best for their patients, but without intentional effort, providers may be unconsciously short-changing their patients. . . and patients may also be complicit in risking their own outcomes. (Blair, et.al, p. 74) Essentially, we are in a relationship where one party’s behavior affects the other, and vice versa.

This research has been growing for the past fourteen years. There are some valiant efforts to change things in pockets of the health care industry. So how can we expand the message and reach all providers and patients in a comprehensive and effective way?

  • The first thing to do is acknowledge that health care disparities are real and that we all participate in maintaining them.
  • Then we need to identify those areas we can influence. Certainly, this is a time where policy and legislation is at the forefront of our attention…so yes, call, write, lobby, do what you can and what you believe to move our nation forward, so that we can have equitable and effective health care for all.
  • And finally, we need to look at ourselves and identify effective ways to challenge our own biases so that we provide and receive the best possible health care.

Receive you ask? Yes, receive. I had a responsibility in that partnership too. Why didn’t I ask my doctor why he thought it was okay for me to be uncomfortable for a year? Yes, I did assume that he was treating me like a little old lady and that my physical activity didn’t matter. I did not speak up or take the time to challenge my assumptions or his. I was complicit in maintaining disparate treatment – even if the answer to my question was that he would have treated a 40 year old man the same way. I was complicit because our relationship was damaged. I lost trust in him and discounted his investment in me. He did not have an opportunity to reflect on whether, in fact, he was making incorrect assumptions about me – and “little old ladies” like me.

Although research has not yet identified proven strategies for providers or patients, there are a number of promising approaches that have been found to reduce unconscious bias. Here are some recommendations that appear repeatedly in the literature. (van Ryn, Blair et.al., FitzGerald & Hurst)

  1. Practice perspective taking — how might the other person feel? What might they be thinking?
  2. Remember that we are all human and all individuals. Providers need to see their patients as individuals. Patients need to recognize that their providers are human and imperfect.
  3. Develop empathy – listen to the feelings behind the words, observe non-verbal cues – and then address what you see and hear.
  4. Increase partnership building and see the provider-patient relationship as a partnership. When we are in it together, we consider the other as part of our group, which increases caring, empathy and trust. When we are in a partnership, we can and must speak up, question assumptions, and provide feedback.
  5. Counter stereotypes. This action has been proven to have the strongest evidence for change. Decrease negative stereotypical cues and seek out and attend to information and images that are contrary to the stereotypes. This takes intentional effort!! Professor Margaret Whitehead, head of the World Health Organization (WHO) Collaborating Centre for Policy Research on Social Determinants of Health states that, “Once learned, stereotypes and prejudices resist change, even when evidence fails to support them or points to the contrary. People will embrace anecdotes that reinforce their biases, but disregard experience that contradicts them.” (cited in Blair et.al., p. 1)
  6. Increase positive interactions with people of difference.
  7. Manage stress levels and cognitive load. When we are overloaded and in high stress situations, we revert back to stereotypes in order to reduce mental demand necessary to cope.

If we truly want to improve the patient experience (as providers and as patients), we need to be serious about building genuine relationships. This requires trust, honesty, and recognition of our human frailties. It requires us to be mindful of our biases and help each other challenge them. How else will become conscious of that which is unconscious? How else will we ensure the best possible care?


Blair, I., Steiner, J., & Havranek, E. (Spring 2011). Unconscious (Implicit) Bias and Health Disparities: Where do we go from here? The Permanente Journal, Volume 15 No. 2. retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140753/

The Joint Commission, Division of Health Care Improvement, (2016). Implicit Bias in Healthcare, Quick Safety Issue 23. Retrieved from


FitzGerald, C. & Hurst, A. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics, 18:19. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333436

van Rynd, M. 2015. Unconscious Bias in Healthcare. APHA Webinar on Unequal Treatment: Disparities in Access, Quality and Care. Retrieved from


Smedley, B., Stith, A. and Nelson, A. Eds, (2003). Unequal Treatment, Confronting Racial and Ethnic Disparities in Healthcare. National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25032386

Unmet Expectations, Created in Isolation?

We sat in the driveway, my sister and I, each peering out our opposite windows, each wrapped in the disappointing sense that we had failed one another while the uncaring car simply idled in the background. “We agreed on this” my sister said, still without turning her face toward me. “No, you told me how we were going to do this, and I said nothing” was my response as I also turned toward my own window. Somehow, she thought my silence meant I agreed. Somehow I thought my silence would indicate I did not agree. Just as the view was different for each of us through our opposing windows, we had an entirely different and singular understanding of what we had agreed on. The spoken and unspoken expectations we had of one another had dragged us unwittingly toward this predictable moment of upset and disappointment.
We carry all kinds of expectations into our days – expectations about relationships, performance, quality standards, purchases – nearly anything we encounter in the details of our personal and professional lives. What makes expectations challenging is that they are unilateral, often unexplored, and are frequently made known in either vague or authoritative ways – or both. Most people resent expectations – especially authoritative and unreasonable expectations – although they may try in earnest to meet them. On the other hand, most people like to keep agreements that are co-authored – to have the chance to agree to what you can count on from them.
Take a seat in any break room, boardroom, meeting room, or bedroom and you are sure to hear complaints, the drone of disappointment, and the bitterness of having been let down. You can hear the utter disbelief that the world didn’t come through for you or me (or Bobby McGee) in the way that it was supposed to, the way that it should have – the way that it would have if anyone cared enough! We might hear something like “he really let me down” or “she should have known better” or “I can’t count on anyone but myself” or, perhaps the most poignant of all, “If he REALLY loved me, he’d know. I shouldn’t have to ask.” When that is the conversation, we are living in the realm of unmet spoken or unspoken expectations.
And when we operate in the realm of expectations – when we engage in our relationships expecting that people will behave the way we want them to, want exactly what we want, understand in tandem with how we see the world, we set the stage for one of two outcomes. We will either feel disappointed or we will feel nothing at all. If others fail to meet our expectations, we will feel upset and disappointed. If others actually meet our expectations, we may not feel anything at all, because that is simply, without celebration, what we expected. It is, after all, the very least they can do!
Disappointment can sink you like a stone and yet, with a simple rearrangement in our thinking, disappointment can be significantly minimized if not eliminated.
What if our complaints could be turned into requests? When we first notice we are disappointed and hosting a complaint we can choose to gain a little altitude and ask ourselves if we have a request of that person. Is there something inside the complaint itself that actually assists us in recognizing what it is that we want or need to bring about success and dissipate the potential for disappointment? What if we simply, then, made that request?
Of course, making a request does not assure an agreement will be established. It does, however, open the possibility of co-authoring a strong, solid agreement that reflects everyone’s voice. Making a request is bold, and courageous, and an act of integrity. It is the first step in negotiating an agreement that brings all the invisible barriers and potential to the table.
But what if a request is made, and the answer to the question “can you agree to this” is no? That’s when we can ask questions that can point us toward agreement:

  • What are you willing to do, if it isn’t this?
  • Here’s what you can count on from me. What can I count on from you?
  • What would you need from me (the organization) to support you in an agreement like this?
  • What do you think we would need to do to make this even better?
  • What might get in the way of us keeping this agreement with each other?
  • We can use our imagination and perception to create an authentic agreement that can be honored by everyone because it was formed by everyone.

Before closing the deal, check on the strength of the agreement. People may mumble that they agree when, in fact, there is still something standing in the way of their being “all in.” If the phrase “I’ll try” shows up anywhere in the conversation, there is no real agreement. Trying suggests that there is doubt, disagreement with the overall direction, and a remnant of unwillingness that puts the agreement at risk of being broken.
Of course, there are still times when even an agreement that seems strong is broken. This is the time to review the agreement in slow motion:

  • What was the actual response to the request?
  • What exactly did they say they were going to do? Was it the same thing you were asking for?
  • Was it a strong agreement with specifics?
  • Is there something that was left hanging? A little loose?

Expectations are hard on the human heart and mind and allow us to shift blame to anyone else but ourselves. Agreements offer us the opportunity to co-author the path by which we move life along in more effective and generous ways and enhance our self esteem by the simple act of taking personal responsibility for our yes’s and no’s. Agreements tap into the creative process, honor the relationships we have at work and at home, rescue us from the disappointment of failed expectations, and save the time often spent in places like an idling car on a gray winter day staring out the window wondering what went wrong.

Compassionate People Have the Best Boundaries

In her book, Rising Strong, Brené Brown shares a profound insight.  She states, “very early on in my work I had discovered that the most compassionate people I interviewed also have the most well-defined and well-respected boundaries. It surprised me at the time, but now I get it. They assume that other people are doing the best they can, but they also ask for what they need and they don’t put up with a lot of crap. Compassionate people ask for what they need. They say no when they need to, and when they say yes, they mean it. They’re compassionate because their boundaries keep them out of resentment.”
In my work as a coach, I have frequently heard people describe their frustrations with doing things they didn’t want to do, shouldn’t have to do and downright resented.  And most of the time, they did not share their feelings or experience with the person who they saw as the source of that frustration.
Situations included having to pick up other people’s shifts, finish their unfinished work, do assignments, meetings and trips that others did not want to do. And my coachees gritted their teeth, smiled on the surface, and did it.  When they shared their stories with me they were angry, hurt, resentful, enraged…and as Brené Brown describes, self-righteous. And it was eating at them. They were indignant.
So how do people get into these binds?  Brown talks about mindset differences.  She discusses the difference in belief that “people are doing the best they can,” versus “people aren’t doing their best.” She claims that it is not the situation, but our beliefs and thoughts about what is happening that drives our response.
I have a colleague who frequently cancels meetings, postponing our ability to get work done. She always has great reasons for the cancellations and I do believe they are true.  However, I am unbelievably frustrated because I am gridlocked on a project without her. Have I told her?  How could I? Her explanations each time are real, meaningful and serious…but, our relationship is crumbling right along with the project.  I am starting to see her as flaky, not-to-be-trusted.  I am looking for work-arounds to remove her from the project to get it done.
It makes sense, doesn’t it? But what is the point of confronting her when her reasons are so justified?
The most critical part of a relationship, whether work or personal, is trust.  I can self-righteously proclaim that she is violating my trust by not following through with her commitments.  But on the other side, I am violating her trust by not telling her what I need.
My self-righteousness suggests that “she should know, shouldn’t she? She just doesn’t care, so why bother?”  What is really happening here?  I am assuming she is not doing the best she can. I have lowered my opinion of her.
I am an equal co-partner in destroying the relationship and not getting the best for our project. What would happen if I assume good intent? What would happen if I share how I am feeling about the project and her involvement? What would happen if I tell her what I need? Perhaps a beginning could sound something like this. . .
“I know you have had a lot of things come up that have interfered with getting this work done. I respect that you have had different priorities. However, I am really frustrated because I cannot continue my work without your input.  I need to know if you are in or if I should develop a different plan to get this done. If you are in, I need to have a meeting with you this week. I will work with your schedule, but if you cancel again, I am going to have to work on it independently.”
Is the language too harsh? Will I lose our relationship? Well, I ask, do we have one now?  What might she say? How might this impact my sense of self if I regain a way forward?
Generally, we avoid conversations like the one above because we are uncomfortable with being so direct.  We hint, make side comments, vent with other people and luxuriate in our own self-righteous indignation…or we wait until they really cross the line and blow up!  All to avoid having an honest, uncomfortable conversation.
Patrick Lencioni believes that trust is fundamental to high functioning teams. He talks about trust as being deeper than just doing what we say we will do, he talks about vulnerability (and so does Brown, a lot!) – a willingness to be open, honest and mistaken.  Owning how I am impacted by other people is a very vulnerable place to be…owning resentment, frustration, discomfort.  But it is the way forward to being more effective as an individual and as a leader.
We have to take the risk.  So how do we do it? It takes courage and SCILLSS. When we are trying something new or different, having a structure can help us succeed.  Here is a quick summary of some steps that can guide us until these conversations become second nature.
1.  S: Self-assessment
How am I feeling? Can you identify what you are feeling…can you get past mad – mad is often a default that covers more uncomfortable feelings like hurt, disrespected, left out.
What am I telling myself? Remember mindset differences? This is the most critical part of the process because our feelings are generated from our thoughts. If I think they should know better, I react one way. If I think they are doing the best they can, I open up possibilities to different reactions.
What else could be going on? Explore other possibilities – why else might they be acting/doing what they are doing?
2. C: Cue to invite conversation
If we are taking the risk of having an uncomfortable conversation, let the other person know what is going on.  “I’d like to discuss something with you if you have a minute… Is this a good time?”Is this a good place?
3. I: Use I-messages
How we describe our concern will impact their response.  Be careful of judgmental or accusatory words that come out of what we are telling ourselves. As much as possible be objective and descriptive.  You might want to write down a few notes for this step.
When you … (objective, behavioral – watch for judgments)
I feel… (use a feeling word – avoid saying “that you…” after “feel”) This is where you get really vulnerable – how are you experiencing what is happening…
Because… (how does this impact me, the work environment or product, our customers/clients?)
4. L: Listen to response and paraphrase what you have heard
Remember, this is about relationship and building trust. Take time for the other person to respond and share how they see the situation. Then explain more of your point of view if needed.
5. L: Listen some more to response and paraphrase until both perspectives are understood.
6. S: Seek a solution that works for both/all parties involved.
Now you get to figure out how to change from a frustrating situation to a productive solution.  Can you see how this can build trust?
Ask, “how can we solve this?”
Brainstorm possible strategies
Write down possibilities
All possibilities – no commentary
Then identify those that would help and both can agree to
7. S: See if it works
We frequently forget this step.  It is possible that the solution or agreement you came up with will not work or only partially address the situation. You might need to revisit things to get it right.  Additionally, change takes conscious and mindful effort. Think of times you tried to change a personal behavior (think diet, exercise or flossing…). How often do we say we’ll do it, and then forget about it?  Setting a time to check back holds us all accountable. It will make a difference in your results. Really!!!
Agree to try a solution for a certain amount of time
Set a time to check back to see if it is working or what needs to be fine tuned
What do you think?  I would love to know if you have taken the risk and tried to have this kind of conversation.  How did it go?  Being a leader means stepping up, being honest, building trust and holding ourselves and others accountable; in essence, being compassionate with strong boundaries. Good luck!
Brown, B. (2015-08-25). Rising Strong: The Reckoning. The Rumble. The Revolution (Kindle Locations 1700-1707). Random House Publishing Group. Kindle Edition.
Lencioni, Patrick M. (2012-03-14). The Advantage, Enhanced Edition: Why Organizational Health Trumps Everything Else In Business (J-B Lencioni Series) (p. 27). Wiley. Kindle Edition.

Preparing Next Generation Leaders

Preparing Next Generation Leaders – can we change or just get out of the way?

by Rory Gilbert, M.Ed., SPHR, SHRM-SCP

In my work, I have often heard people complain about millennials…even millennials complain about each other! Millennials (MLs) are described as needy, slackers, demanding instant gratification and constant feedback. They don’t want to pay their dues and want to be able to speak up and contribute right now! They don’t know their place and they are not loyal to the company. They keep talking about work-life balance – where is their dedication?i

We also know that as boomers retire, especially in leadership positions, there are not enough folks to replace them without an infusion of millennial talent and energy. People worry because they believe MLs are not prepared, not ready for leadership.

I would challenge those of us who see this dilemma to revisit three things.

  • What do we know are best practices to create successful organizations?
  • How do MLs fit into these recommended best practices?
  • What do we need to do to prepare MLs for the leadership demands of the future?

So, what makes an organization successful in the current environment?

Alex and David Bennetii tell us that organizations must be able to adapt quickly to change. This means hiring people, not positions. Organizations need capable, competent people who can be assigned projects that use their skills and develop their skills. People need content knowledge and the ability to collaborate well with others to respond effectively and creatively.

People need to be clear about the organization’s mission and empowered to make timely decisions within their field of influence to respond to changes in the environment. People need to be willing to take risks. Hierarchies and overly controlled environments do not allow for this type of activity.iii

Patrick Lencioni emphasizes that taking needed risks requires a deep level of trust in the organization from leaders to employees – that they will act in the best interest of the company, and that they have the knowledge and ability to make good decisions. And for employees, when (not if) they make mistakes, it is essential that leaders back them up and support them in learning from and correcting those mistakes. To do so, leaders need to provide quick and clear feedback, advice and counsel. iv

When there is an environment of deep trust like this, an organization can have true accountability – where people own their actions and decisions, speak up about concerns, work together to take the best actions and make the best decisions. In a truly accountable organization, people can easily review, learn from and rapidly respond to mistakes, so there is as little negative impact as possible. v

Harvard Business Review identified the leadership competencies that were most important for all management positions. Among the top competencies were inspiring and motivating others, displaying high integrity and honesty, communicating powerfully and prolifically, collaborating and promoting teamwork and building relationships. Displaying technical or professional expertise finally emerged eighth on the list. vi This list indicates the importance of interpersonal skills for effective leadership.

How do millennials fit into these best practices? I would suggest they fit perfectly if we reframe the attributes so often used to describe them.

They are ready for a challenge, want to learn and try new things and want honest, supportive feedback. They recognize people for their skills and contributions not their titles, and they want to be recognized for what they can contribute as well. They seek resources that will help them solve problems, rather than relying on stifling chains of command.vii

They want strong, genuine and honest relationships with their leaders. They count on rapid feedback that allows for quick course-corrections so they can be successful. viii

When they feel valued by their organizations and see opportunities to advance, MLs prefer to remain with their organizations. They are loyal when the organization’s values and goals are aligned with their own. ix

They commit to giving 100% when they are on the job and are wise enough to believe what we say (but not what we do), that we perform better when we take time to refresh and rejuvenate. While they are wired in 24/7, that doesn’t mean they want to work 24/7. x

What do we need to do to prepare Millennials for the leadership demands of the future?

I believe we need to follow the lead of MLs in creating the organization of the future. We need to support environments that are flexible, non-hierarchical and capitalize on their greatest asset, people.

That means letting go of some archaic notions. Things like:

  • what it means to pay one’s dues
  • the number of hours at the office demonstrates commitment or ability
  • setting boundaries on work time means slacking or disloyalty
  • speaking up too soon is a sign of disrespect
  • trying something new and failing is dangerous

We need to look at what people are capable of doing rather than being limited by job titles, and then let them have a chance to try something new! And we need to build genuine relationships that allow for risk-taking, creativity, innovation and adaptability. For millennials, this is the standard they are seeking.

This means providing information, context and mentorship for our emerging leaders and providing them with growth opportunities to test their abilities and learn from failure.

This means demonstrating how to give and take constructive feedback, manage conflict respectfully, admit our mistakes and learn from others. These are critical skills for the next generation of leaders. No one knows it all, but in strong and collaborative environments, a leader can facilitate making the most of what everyone knows.

None of these skills is new. Leadership books have been espousing them for years…but most of us have not mastered them…or in many cases even tried. xi Millennials come to us ready to embrace a supportive, collaborative, adaptive environment. Now is the time to shape that future. Organizations cannot afford to make MLs conform to leadership styles that are destined to fail. We need to model the new way of being (even if imperfectly) or it may well be time to get out of the way.

Updated 4-3-17:  Just read this article. It reinforces my main points. Check it out.


iMillennials have been labeled as lazy, entitled, and narcissistic, with an innate distrust of bureaucracy and authority. This generation is also known for being difficult to manage in the workplace and prone to job-hopping. For better or worse, Millennials now make up the largest generation in the U.S. labor force which means it’s time for employers to start adapting to an ever-changing workforce.” http://www.inc.com/sujan-patel/6-tips-for-managing-millennials.html

ii Bennet, Alex and David (2011). Organizational Survival in the New World. Routledge Taylor and Francis Group: New York.
iii Bennett, Alex and David (2011).

iv Lencioni, Patrick. (2012) The Advantage: Why Organizational Health Trumps Everything Else In Business. Jossey-Bass:San Fransisco.

v Lencioni, Patrick (2012).

vi https://hbr.org/2014/07/the-skills-leaders-need-at-every-level

Top skills ranked in order: inspires and motivates others, high integrity and honesty, solves problems and analyzes issues, drives for results, communicate powerfully and prolifically, builds relationships, displays technical or professional expertise…

vii Shaw, Haydn (2013-07-22). Sticking Points: How to Get 4 Generations Working Together in the 12 Places They Come Apart. Tyndale House Publishers, Inc.. Kindle Edition.

viii Shaw, Haydn (2013-07-22).

x Shaw, Haydn (2013-07-22).
xi Consider the body of work of Peter Drucker, Peter Senge, Kouzes and Posner, Jim Collins, Margaret Wheately and many others.